Provider Demographics
NPI:1508496605
Name:HOAGLIN, MISTIE JOLENE
Entity Type:Individual
Prefix:
First Name:MISTIE
Middle Name:JOLENE
Last Name:HOAGLIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 W 4950 S APT A
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84405-6321
Mailing Address - Country:US
Mailing Address - Phone:801-695-2230
Mailing Address - Fax:
Practice Address - Street 1:523 HERITAGE PARK BLVD
Practice Address - Street 2:
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-5711
Practice Address - Country:US
Practice Address - Phone:801-525-9998
Practice Address - Fax:801-525-6984
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-17
Last Update Date:2020-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker